The final FY 2026 SNF PPS payment rate updates, effective October 1, 2025, are now integrated into our PDPM Rate Calculator, developed in collaboration with Data IQ. For your convenience, key updates are summarized below.
Updates to Our PDPM Rate Calculator
- PDPM Rates: 2026 rates to compare by site, HIPPS, Wage Index, and VBP
- CMI: Case Mix Index and rate per CMG by selected provider
- YOY Change: 2025 vs. 2026 PDPM rate comparison
- Part B: Reflects 2025 rates until finalized & published for January 2026
FY 2026 CMS Highlights
SNF Payment Rate Changes
- 3.2% net increase to SNF payment rates for FY 2026
- 3.3% market basket update
- +0.6% forecast error adjustment
- –0.7% productivity adjustment
- Estimated aggregate impact: +$1.16 billion in SNF PPS payments
ICD-10 Mapping Revisions
- 34 PDPM ICD-10 code updates to better align diagnoses with clinical categories and skilled intervention criteria
SNF Value-Based Purchasing (VBP)
- Removes the Health Equity Adjustment from the scoring methodology
- Finalizes statutorily required performance standards for Program measures
- Adopts a new reconsideration process and technical updates to the regulation text
SNF Quality Reporting Program (QRP)
- Removes four standardized patient assessment data elements under Social Determinants of Health
- Finalizes proposal to amend the reconsideration policy and process, allowing SNFs to request extensions and updating CMS’s criteria
Extraordinary Circumstance Exception (ECE)
- Expands policy to allow CMS to grant extensions for SNFs impacted by extraordinary events
The Point Is: Be sure the updated FY 2026 rates are being shared and utilized by your team. The QRM PDPM Rate Calculator is a comprehensive tool to help the entire IDT view reimbursement rates, facility trends, and year-over-year shifts so you can stay ahead with confidence. Please let us know if we can be of help.
